Professional Documents
Culture Documents
Consensus on a Multidisciplinary
Treatment Guideline for de Quervain
Disease: Results From the European
HANDGUIDE Study
Bionka M.A. Huisstede, J. Henk Coert, Jan Friden, Peter Hoogvliet;
for the European HANDGUIDE Group
Conclusions. This multidisciplinary treatment guideline may help in the treatment of and research on de Quervain disease.
August 2014
Volume 94
Number 8
1095
Physical Therapy
Volume 94
Method
Steering Committee and
Advisory Team
A steering committee to initiate and
guide the HANDGUIDE study comprised a hand surgeon, a physical
medicine and rehabilitation (PM&R)
physician, and a physical therapist.
All 3 members have PhD degrees as
well as a clinical and a scientific or
epidemiological background. They
designed the questionnaires, ana-
Number 8
Table 1.
Evidence for the Effectiveness of Interventions for de Quervain Diseasea
Interventions
Evidence
Nonsurgical
Physical therapy
Oral
ND
Injection
Other
ND
Surgical
ND
Postsurgical
ND
Searches in PubMed, EMBASE, CINAHL, and PEDro up to February 2009. NCrandomized controlled
trial found, but no comparison between the intervention and control group was made, so no evidence
was found; NDno data; NEno evidence found for effectiveness of the treatment (randomized
controlled trials available, but no differences between intervention and control groups were found).
Table 2.
Experts Criteria for Participation in the Delphi Consensus Strategy
Criteria
experta
The
should be a medical or health care professional with considerable
experience in treating patients with nontraumatic hand disorders
(tendinopathies, Dupuytren disease or neuropathies, respectively)
Participating hand surgeons and hand therapists participated as delegates for their respective
professional association.
Volume 94
Number 8
Physical Therapy f
1097
Physical Therapy
Volume 94
Results
Expert Panel
A total of 112 experts (52 hand surgeons, 47 hand therapists, and 13
PM&R physicians) from 17 European
countries were selected to participate in 1 of the 3 Delphi consensus
strategies of the HANDGUIDE study,
which was performed between June
2009 and December 2012.
Number 8
Profession
(European
Federation)
Participating Countries
Total No. of
Experts in the
HANDGUIDE
Study
No. of
Experts
Years of
Experience
X (Range)
Hand surgeons
(FESSH)
52
14
15.2 (830)
Hand therapists
(EFSHT)b
47
16
17.5 (633)
PM&R physicians
13
16.0 (1020)
112
35
16.5 (633)
Total
a
FESSHFederation of European Societies for Surgery of the Hand, EFSHTEuropean Federation of Societies for Hand Therapy, PM&Rphysical medicine
and rehabilitation.
b
Physical therapists and occupational therapists specializing in the treatment of hand disorders.
August 2014
Volume 94
Number 8
Physical Therapy f
1099
Goal
Level 1: activity
Specific
Avoid
Avoid
Avoid
Avoid
Avoid
Avoid
Level 3: pain
Table 6.
Kinds of Splints Presented in The FirstRound Questionnaire
Kind of Splints Used in Clinical Practice
for de Quervain Disease:
1 Short hand-based (wrist free) splint
including the interphalangeal (IP) joint
of the thumb (S-IPin)
2 Short hand-based splint excluding the IP
joint of the thumb (S-IPex)
3 Long lower arm-based (wrist immobilized)
splint including the IP joint of the
thumb (L-IPin)
4 Long lower arm based splint excluding
the IP joint of the thumb (L-IPex)
Physical Therapy
Volume 94
Number 8
The
experts
agreed
that
intermediate-acting corticosteroid
injections, such as methylprednisolone or triamcinolone, should be
used in the treatment of de Quervain
disease and that a local anesthetic
should be added. The maximum
number of injections is 1 to 3. Consensus also was achieved on the
advice that should be given to the
patient after this treatment. This
advice should focus on 2 items: (1)
possible adverse effects as a result of
the corticosteroid injection, including pain should not be present for
longer than 2 days and, in case of the
presence of diabetes, the patient
should monitor his or her blood glucose level, and (2) the patient should
rest the hand for 1 to 7 days and
avoid strain on the structures
involved in de Quervain disease.
Consensus was achieved on the use
of open surgery (in preference to
percutaneous or other surgical techniques), using a transversal or longitudinal incision (in preference to
Brunner-type, Lazy S, and other
[oblique] incisions), and the use of
nonresorbable sutures under local
anesthetic.
The experts also agreed on the recommendations that should be given
to the patient for treatment during
August 2014
Table 7.
Subgroups Related to the Severity and Duration of de Quervain Disease
5 Subgroups for Severity
Symptoms
1: very mild
2: mild
3: moderate
4: severe
5: very severe
Pain
Duration (Stage)
2: 12 mo (subacute)
3: 23 mo (subacute)
4: 36 mo (chronic)
1: 1 mo (acute)
5: 6 mo (chronic)
Discussion
Volume 94
Number 8
Physical Therapy f
1101
Physical Therapy
Volume 94
Number 8
August 2014
Volume 94
Number 8
Physical Therapy f
1103
References
ber eine Form von chro1 de Quervain F. U
nischer Tendovaginitis. Korrespondenz rzte. 1895;25:389
Blatt fu
r Schweizer A
394.
1104
Physical Therapy
Volume 94
Number 8
August 2014
EMBASE
CINAHL
Quervain* or DeQuervain* or ((abductor and pollicis) and (long or longus)) or (extensor and pollicis and
brevis)
PEDro
De Quervain disease
EMBASE
CINAHL
PEDro
((meta-analysis [pt] OR meta-analysis [tw] OR metanalysis [tw]) OR ((review [pt] OR guideline [pt] OR
consensus [ti] OR guideline* [ti] OR literature [ti] OR overview [ti] OR review [ti]) AND ((Cochrane [tw]
OR Medline [tw] OR CINAHL [tw] OR (National [tw] AND LIbrary [tw])) OR (handsearch* [tw] OR
search* [tw] OR searching [tw]) AND (hand [tw] OR manual [tw] OR electronic [tw] OR bibliographi*
[tw] OR database* OR (Cochrane [tw] OR Medline [tw] OR CINAHL [tw] OR (National [tw] AND
Library [tw]))))) OR ((synthesis [ti] OR overview [ti] OR review [ti] OR survey [ti]) AND (systematic [ti]
OR critical [ti] OR methodologic [ti] OR quantitative [ti] OR qualitative [ti] OR literature [ti] OR
evidence [ti] OR evidence-based [ti]))) BUTNOT (case* [ti] OR report [ti] OR editorial [pt] OR comment
[pt] OR letter [pt])
EMBASE
CINAHL
PEDro
(Continued)
August 2014
Volume 94
Number 8
Physical Therapy f
1105
(randomized controlled trial[pt] OR controlled clinical trial[pt] OR randomized controlled trials [mh] OR
random allocation [mh] OR double-blind method [mh] OR single-blind method [mh] OR clinical trial [pt] OR
clinical trials [mh] OR (clinical trial [tw]) OR ((singl* [tw] OR doubl* [tw] OR tripl* [tw]) AND (mask* [tw]
OR blind* [tw])) OR (latin square [tw]) OR placebos [mh] OR placebo* [tw] OR random* [tw] OR research
design [mh:noexp] OR comparative study [pt] OR evaluation studies [pt] OR follow-up studies [mh] OR
prospective studies [mh] OR cross-over studies [mh] OR control[tw] OR controls [tw] OR controlled[tw]
OR controled[tw] OR control*[tw] OR prospectiv* [tw] OR volunteer* [tw]) NOT (animals [mh] NOT
humans [mh])
EMBASE
CINAHL
PEDro
a
For the review search, strategies 1, 2, and 3 were combined. For the randomized controlled trial (RCT) search, strategies 1, 2, and 4 were combined.
Appendix 2.
Levels of Evidence for Effectiveness Used in the Systematic Review
1. Strong evidence for effectiveness: consistent,a positive (significant) findings within multiple higher-quality
randomized controlled trials (RCTs).
2. Moderate evidence for effectiveness: consistent, positive (significant) findings within multiple lower-quality RCTs
or one high-quality RCT
3. Limited evidence for effectiveness: positive (significant) findings within one low-quality RCT
4. Conflicting evidence for effectiveness: provided by conflicting (significant) findings in the RCTs (75% of the
studies reported consistent findings)
5. No evidence found for effectiveness of the inventions: RCTs available, but no (significant) differences between
intervention and control groups were reported
6. No systematic review or RCT found
a
1106
Physical Therapy
Volume 94
Number 8
August 2014
August 2014
Volume 94
Number 8
Physical Therapy f
1107
1108
Physical Therapy
Volume 94
Number 8
August 2014
August 2014
Volume 94
Number 8
Physical Therapy f
1109
1110
Physical Therapy
Volume 94
Number 8
August 2014